Patterns and persistence of behavioural and psychological symptoms in those with cognitive impairment: the importance of apathy

Abstract

van der Linde, Rianne M. and Matthews, Fiona E. and Dening, Tom and Brayne, Carol (2016) Patterns and persistence of behavioural and psychological symptoms in those with cognitive impairment: the importance of apathy. International Journal of Geriatric Psychiatry . ISSN 0885-6230Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/33569/1/VanderLinde%20IJGP%20apathy_Revised %20Paper%20-%20changes%20accepted.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the University of Nottingham End User licence and may be reused according to the conditions of the licence. For more details see: http://eprints.nottingham.ac.uk/end_user_agreement.pdf A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. Table 1: One year transition rates taking into account age only Table 2: One-year mortality risk of those with a symptom compared to those without Table 3 Table 1: Baseline prevalence of symptoms, including how many are excluded because single transition Online Additional Table 2: Baseline characteristics Online Additional Table 3: Symptom presence, missing values, loss to follow-up and drop out due to death across the follow-up period Online Additional Table 4: Number of transitions for each of the symptoms Online Additional Table 5 Hazard ratio of the association between symptom history and transition rates in those with at least 2 interviews Online Additional Table 6 Sensitivity analysis comparing transition rates for an apathy definition based on participant interviews only to transition rates based on both participant and informant interviews 3 AbstractObjective To study the stability and emergence of a range of Behavioural and Psychological Symptoms (BPS), their association with mortality and the effect of covariates on these transitions in a population based study of cognitively impaired older people with a long follow-up period and large sample size, with a particular focus on apathy.Methods Data were from a population-based, longitudinal cohort study of ageing.Interviews were conducted at 0, 2, 6, 8 and 10 years with 3,626 participants aged 65+.The persistence of 11 BPS and their association with mortality in those with cognitive impairment (MMSE 25 or below) was investigated using multistate models, allowing us to take into account estimations of the probability of transitions that occurred in the time between interviews.Results Most BPS were persistent. Apathy was one of the most stable symptoms; in those with apathy, the probability of still having apathy after 1 year is 62%. Apathy, sleep problems, depression, irritability and wandering were most likely...

Repetitive transcranial magnetic stimulation for apathy in mild cognitive impairment: A double-blind, randomized, sham-controlled, cross-over pilot study

“…Apathy appears early during MCI, increases in severity as the disease progresses, and tends to have a chronic course. In a population based study of older adults followed over ten years (N=3626), apathy was noted to be highly prevalent at 31.9%; and symptoms persisted for at least one year in 62% of subjects with apathy (van der Linde et al, 2016). Furthermore, the mortality rate among those with apathy was 3.1 times higher compared to those without apathy (van der Linde et al, 2016).…”

“…Although, there is some overlap with depressive symptoms, several groups have established apathy as a distinct entity lacking symptoms of dysphoria, suicidal ideation, self-criticism, feelings of guilt, and hopelessness (Levy et al, 1998). The prevalence of apathy in MCI has been reported to be as high as 60.5% (Ellison et al, 2008;Hwang et al, 2004;Lyketsos et al, 2002;van der Linde et al, 2016). Apathy appears early during MCI, increases in severity as the disease progresses, and tends to have a chronic course.…”

“…In a population based study of older adults followed over ten years (N=3626), apathy was noted to be highly prevalent at 31.9%; and symptoms persisted for at least one year in 62% of subjects with apathy (van der Linde et al, 2016). Furthermore, the mortality rate among those with apathy was 3.1 times higher compared to those without apathy (van der Linde et al, 2016). Presence of apathy leads to rapid progression of symptoms and up to seven-fold rate of conversion to AD (Palmer et al, 2010).…”

Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

“…Apathy contributes to a poorer quality of life and a faster rate of cognitive decline (Tierney, Woods, Weinborn, & Bucks, 2018;Yonas et al, 2014). Additionally, risk of mortality in those with apathy increases by over three times compared to those without apathy (van der Linde, Matthews, Dening, & Brayne, 2017). Those caring for people with apathy are also affected with higher carer burden reported when compared with other symptoms (Dauphinot et al, 2015;Lou et al, 2015).…”

Symptoms of apathy and passivity in dementia: A simultaneous concept analysis

“…Apathy in dementia is associated with a range of adverse outcomes including cognitive decline, increased risk for nursing home placement and significant distress for family caregivers (Massimo et al, 2009). Apathy also has a strong association with mortality and a negative impact on management of comorbid conditions and disability (van der Linde, Matthews, Dening, & Brayne, 2017). Passivity or "passive behavior" is a similar concept that has been studied in the field of dementia and refers to a "reduction of energy, drive and initiative.…”